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Medical documentation, bioanalytical evidence of an accidental human exposure to sulfur mustard and general therapy recommendations

TitleMedical documentation, bioanalytical evidence of an accidental human exposure to sulfur mustard and general therapy recommendations
Publication TypeJournal Article
Year of Publication2016
AuthorsSteinritz D., Striepling E., Rudolf K.D, Schroder-Kraft C., Puschel K., Hullard-Pulstinger A., Koller M., Thiermann H., Gandor F., Gawlik M., John H.
JournalToxicol Lett
Date PublishedFeb 26
ISBN Number1879-3169 (Electronic)0378-4274 (Linking)
Keywords*Accidents, *Documentation, Adult, Albumin adducts, Blister/*chemically induced/diagnosis/therapy, CHEMICAL WARFARE AGENTS, Chemical Warfare Agents/metabolism/*poisoning, Chromatography, Liquid, Erythema/*chemically induced/diagnosis/therapy, Gas Chromatography-Mass Spectrometry, Humans, Irritants/*poisoning, Male, Middle Aged, Mustard Gas/metabolism/*poisoning, Poisoning/diagnosis/therapy, Protein Binding, Remission Induction, Serum Albumin, Human, Serum Albumin/metabolism, Severity of Illness Index, Skin/*drug effects/pathology, ss-lyase products, Sulfur Mustard, Tandem Mass Spectrometry, Time Factors, Treatment Outcome, VESICANT

Sulfur mustard (SM) is a chemical warfare agent (CWA) that was first used in World War I and in several military conflicts afterwards. The threat by SM is still present even today due to remaining stockpiles, old and abandoned remainders all over the world as well as to its ease of synthesis. CWA are banned by the Chemical Weapons Convention (CWC) interdicting their development, production, transport, stockpiling and use and are subjected to controlled destruction. The present case report describes an accidental exposure of three workers that occurred during the destruction of SM. All exposed workers presented a characteristic SM-related clinical picture that started about 4h after exposure with erythema and feeling of tension of the skin at the upper part of the body. Later on, superficial blister and a burning phenomenon of the affected skin areas developed. Similar symptoms occurred in all three patients differing severity. One patient presented sustained skin affections at the gluteal region while another patient came up with affections of the axilla and genital region. Fortunately, full recovery was observed on day 56 after exposure except some little pigmentation changes that were evident even on day 154 in two of the patients. SM-exposure was verified for all three patients using bioanalytical GC MS and LC MS/MS based methods applied to urine and plasma. Urinary biotransformation products of the beta-lyase pathway were detected until 5 days after poisoning whereas albumin-SM adducts could be found until day 29 underlining the beneficial role of adduct detection for post-exposure verification. In addition, we provide general recommendations for management and therapy in case of SM poisoning.


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